Injured Workers may be familiar with the delays in obtaining medical treatment under Maryland workers compensation insurance.
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In some cases there are extensive and repetitive delays in obtaining medical treatment through workers compensation insurance. The delays can come from many factors often revolving around the injured workers’ rights but more often the Employer and Insurer’s rights. Like the injured, the Employer/Insurer have certain rights under the workers compensation laws.
Second Opinion Delays
The Employer/Insurer does not legally have to accept the treating physicians recommendation whether it be for surgery, injections, pain medication, physical therapy or other treatment. They are entitled to obtain an Independent Medical Evaluation (IME) from a doctor of their choosing before willingly paying for the treating physicians recommendation. Under Maryland workmans comp laws the treatment must be “reasonable, necessary, and causally related” to the accident at work. This phrase opens up a door to differing opinions and creates the proverbial gray area. What is reasonable to Doctor X may not be reasonable to Dr. Y and what is necessary to Dr. X may not be necessary to Dr. Y. Also, Dr. X and Dr. Y can disagree as to what is causally related to the accident.
When an IME is scheduled it is time to obtain a Maryland workers compensation attorney.
More often then not, the delays in treatment are related to the workers comp Insurer’s right to have an IME performed. The workers comp adjuster will wait until he or she receives the IME report before approving the treatment recommended. IME’s are often scheduled a month or two out and the medical reports can take another few weeks to be issued. If the IME Doctor indicates that the medical treatment is not reasonable, is not necessary, is not causally related, or any combination of these requirements then the delay in treatment continues. When the adjuster denies treatment, or if it is expected that treatment will be denied once the IME is performed, a hearing before the Maryland Workers Compensation Commission will need to be requested. Unfortunately hearings are not held as soon as everyone in the workers compensation community would like and this will again delay the treatment and the conclusion of the case.
It is important to realize that in many Maryland Workman’s Compensation cases there are numerous IME’s performed which means there can be numerous delays. It is not uncommon for an IME to be scheduled and performed based on the reasonableness of some form of treatment recommendation like physical therapy, and soon after a second IME is being performed to determine if another form of treatment is reasonable like an MRI. It is important to know what to expect at the IME.
Once a hearing request is filed with the Maryland Workers Compensation Commission the legal process begins. The waiting period fluctuates for the workers compensation hearing but typically hearings are set-with in three months. The reasons for the waiting period are comparable to the reasons one must wait for any Governement agency or department to act. Often referencing bureaucratic restrictions, budgetary restraint, or excess demand. Occasionally the hearings can be placed on a docket longer than three months, and seldom within one month. Assuming it took two months for the IME to be performed and another three months for the hearing before the Maryland workers compensation commission, the injured employee could expect to wait five months for a determination of whether the work comp insurer will be responsible to pay for the medical treatment. It is best not to assume a five month wait and prepare for a longer period.
Legal delays can also materialize if there is a need for a postponement or continuance of the scheduled hearing. When the case is continued the hearing will typically be reset within two months however occasionally it is sooner. The basis of a qualifying continuance request are numerous and can arise from any party involved in the case including potential witnesses, attorney’s, or, very rarely the Workers Comp Commission.
The best way to prevent delays in the treatment process is to hire a qualified and experienced Baltimore workers compensation attorney early in the process.
Delays in payments may also be expected.